Jejunostomy, end ileostomy, and transverse colostomy management for a patient who underwent laparotomy for faecal peritonitis at a teaching hospital in Ndola, Zambia
The management of an HIV patient with high-output stomas is a big challenge in surgery. Such patients present with physiological derangements that are life-threatening. The prognosis of such patients in our setting is very poor, with a high mortality rate. The outcomes of surgery in HIV/AIDS patients, however, do not depend on the clinical stages of HIV but rather on the CD4 count. The CD4 count has been shown to be a predictor in determining the outcomes of surgery in patients with HIV. In HIV patients, emergency surgery should be done as necessary, but elective surgery is not advised until the CD4 count is above 500. The commonest and most problematic complication of surgery in HIV patients is septic sequelae, which commonly result in increased morbidity and mortality. After intestinal resections encountered in a septic abdomen, a stoma is better than anastomosis, and an early reversal of such should be encouraged in patients with HIV. Correction of dehydration, electrolyte balance, and nutritional support are key to ensuring good outcomes after surgery. A multidisciplinary team approach should be encouraged in managing such patients, as kidney disease, and not septic sequelae, was the cause of death for our patient. We present a patient who was managed with a high-output fistula at Ndola Teaching Hospital, Ndola, Zambia.